Five-Star Hospitals Surge Amid Ongoing Concerns About Ratings Program

Rich Daly, HFMA senior writer/editor

The number of hospitals reporting enough data to garner ratings surged after CMS moved from quarterly updates to semi-annual overall quality star-rating updates.

Dec. 26—The share of hospitals garnering the highest-possible rating under Medicare’s controversial quality-rating system more than quadrupled in the latest update, but hospital advocates remain leery about the program.

Five-star hospitals increased from 83 a year ago to 337 in the latest update of the Centers for Medicare & Medicaid Services’s (CMS’s) Overall Hospital Quality Star Rating program, according to an
update. Also increasing was the number of one-star hospitals, which more than doubled from 112 to 260.

The latest results came in a December update to the overall quality star rating website; CMS had temporarily paused updates while tweaking its formula. Hospital advocates, who had urged formula changes, remain concerned following the release of the latest results.

“While it may be well intentioned, the CMS star ratings program is confusing for patients and families and raises far more questions than answers,” said Marie Johnson, a vice president for the American Hospital Association (AHA), after the latest star-rating update. “These ratings have
also been broadly criticized by quality experts and Congress as being inaccurate and misleading to consumers.”

A Shift in Ratings

The number of two-star hospitals increased from 694 a year ago to 753. The number of middle-tier hospitals was mixed, with three-star hospitals falling to 1,187 from 1,794 and four-star hospitals increasing to 1,155 from 946.

Also notable was that the number of hospitals with enough data to receive an overall star rating increased. CMS reported that 887 hospitals in December did not have sufficient data, which was down from 969 non-rated hospitals in December 2016.

Only hospitals that have at least three measures within at least three measure groups or categories, including one outcome group (mortality, safety, or readmission), are eligible for an overall rating. Not all hospitals report all measures, CMS noted.

The overall star ratings on
Hospital Compare were launched in July 2016 to aggregate quarterly data from existing publicly reported quality measures into a single star rating for each hospital. The website includes information on more than 100 quality measures and about 4,000 hospitals. The
overall star ratings summarize up to 57 quality measures across seven quality areas. Once reporting thresholds are met, a hospital’s overall rating is calculated using only those measures for which data are available. This could include as few as nine or as many as 57 measures. The
average number used in the latest update was about 39 measures, according to CMS.

A hospital’s star rating does not affect its payments from CMS.

Changes Included

A release from CMS about this recent update stated that the agency will respond to stakeholder concerns by updating several existing measures and the overall star rating.

Revisions in this round of updates included “an enhanced methodology,” based on technical expert panel recommendations and public input.

“We continue to refine the Star Ratings and look forward to an ongoing dialogue with hospitals and patients and their families on how we can provide beneficiaries useful information,” said Seema Verma, administrator of the CMS, in a
release.

The latest update included three new measures: hospital survey on patient safety culture; rate of unplanned hospital visits after an outpatient colonoscopy; and percentage of patients receiving appropriate radiation therapy for cancer spread to the bone.

The agency stopped including two other measures: ischemic stroke patients who got medicine to break up a blood clot within three hours after symptoms started; and patients with blood clots who were discharged on a blood thinner medicine and received
written instructions about that medicine.

The star rating updates were part of a CMS review to lower the quality measurement reporting burden on providers, Verma said in an
October speech.

Approach Used

The new star ratings followed a public comment period on
changes that CMS was considering to its overall hospital star-ratings methodology.

Some of the proposed changes were supported by CMS’s Technical Expert Panel this summer. CMS also encouraged stakeholders to run their own analyses of the proposed methodology.

The AHA said the proposed changes addressed some “missteps” related to “errors in the execution of the chosen methodology.”

However, the hospital group noted last summer that CMS’s own analysis showed that the changes would alter star ratings for nearly 700 hospitals, thus “amplifying our concern about the reliability and accuracy of the chosen methodology.”

Among projections compiled by Yale New Haven Health Services Corporation-Center for Outcomes Research and Evaluation (YNHHSC/CORE), with which CMS contracted to conduct an evaluation of the star-rating system, was that the methodological changes would
increase the number of one-star hospitals from 112 to 284 and the number of five-star hospitals from 83 to 278—directionally matching the final outcomes.

The number of hospitals reporting enough data to garner ratings surged after CMS moved from quarterly updates to semi-annual overall quality star-rating updates.

Dec. 26—The share of hospitals garnering the highest-possible rating under Medicare’s controversial quality-rating system more than quadrupled in the latest update, but hospital advocates remain leery about the program.

Five-star hospitals increased from 83 a year ago to 337 in the latest update of the Centers for Medicare & Medicaid Services’s (CMS’s) Overall Hospital Quality Star Rating program, according to an
update. Also increasing was the number of one-star hospitals, which more than doubled from 112 to 260.

The latest results came in a December update to the overall quality star rating website; CMS had temporarily paused updates while tweaking its formula. Hospital advocates, who had urged formula changes, remain concerned following the release of the latest results.

“While it may be well intentioned, the CMS star ratings program is confusing for patients and families and raises far more questions than answers,” said Marie Johnson, a vice president for the American Hospital Association (AHA), after the latest star-rating update. “These ratings have
also been broadly criticized by quality experts and Congress as being inaccurate and misleading to consumers.”

A Shift in Ratings

The number of two-star hospitals increased from 694 a year ago to 753. The number of middle-tier hospitals was mixed, with three-star hospitals falling to 1,187 from 1,794 and four-star hospitals increasing to 1,155 from 946.

Also notable was that the number of hospitals with enough data to receive an overall star rating increased. CMS reported that 887 hospitals in December did not have sufficient data, which was down from 969 non-rated hospitals in December 2016.

Only hospitals that have at least three measures within at least three measure groups or categories, including one outcome group (mortality, safety, or readmission), are eligible for an overall rating. Not all hospitals report all measures, CMS noted.

The overall star ratings on
Hospital Compare were launched in July 2016 to aggregate quarterly data from existing publicly reported quality measures into a single star rating for each hospital. The website includes information on more than 100 quality measures and about 4,000 hospitals. The
overall star ratings summarize up to 57 quality measures across seven quality areas. Once reporting thresholds are met, a hospital’s overall rating is calculated using only those measures for which data are available. This could include as few as nine or as many as 57 measures. The
average number used in the latest update was about 39 measures, according to CMS.

A hospital’s star rating does not affect its payments from CMS.

Changes Included

A release from CMS about this recent update stated that the agency will respond to stakeholder concerns by updating several existing measures and the overall star rating.

Revisions in this round of updates included “an enhanced methodology,” based on technical expert panel recommendations and public input.

“We continue to refine the Star Ratings and look forward to an ongoing dialogue with hospitals and patients and their families on how we can provide beneficiaries useful information,” said Seema Verma, administrator of the CMS, in a
release.

The latest update included three new measures: hospital survey on patient safety culture; rate of unplanned hospital visits after an outpatient colonoscopy; and percentage of patients receiving appropriate radiation therapy for cancer spread to the bone.

The agency stopped including two other measures: ischemic stroke patients who got medicine to break up a blood clot within three hours after symptoms started; and patients with blood clots who were discharged on a blood thinner medicine and received
written instructions about that medicine.

The star rating updates were part of a CMS review to lower the quality measurement reporting burden on providers, Verma said in an
October speech.

Approach Used

The new star ratings followed a public comment period on
changes that CMS was considering to its overall hospital star-ratings methodology.

Some of the proposed changes were supported by CMS’s Technical Expert Panel this summer. CMS also encouraged stakeholders to run their own analyses of the proposed methodology.

The AHA said the proposed changes addressed some “missteps” related to “errors in the execution of the chosen methodology.”

However, the hospital group noted last summer that CMS’s own analysis showed that the changes would alter star ratings for nearly 700 hospitals, thus “amplifying our concern about the reliability and accuracy of the chosen methodology.”

Among projections compiled by Yale New Haven Health Services Corporation-Center for Outcomes Research and Evaluation (YNHHSC/CORE), with which CMS contracted to conduct an evaluation of the star-rating system, was that the methodological changes would
increase the number of one-star hospitals from 112 to 284 and the number of five-star hospitals from 83 to 278—directionally matching the final outcomes.

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